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HomeMy WebLinkAboutInsurance Certificate: Ashland Construction dba SO Concrete Pumping ACOO°® CERTIFICATE OF LIABILITY INSURANCE siJEi2o1`YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Paula Ortiz, CIC NAME: Beecher Carlson Insurance Agency LLC PHONE (541)772-1111 FA% . (541)77]-3785 707 Murphy' Rd' - E-MAa ADDR�,,.paula.ortiz@beechercarlson.com INSURERS AFFORDING COVERAGE NAIC If Medford OR 97504 INSURER A:Ameri can Hallmark Insurance Co INSURED' INSURER B:Assurance Co of America 19305 Ashland Construction Inc, DBA: Southern INSURER C: Oregon Concrete Pumping INSURER D: 102 Pleasant View INSURER E: Talent OR 97540 INSURER F: COVERAGES CERTIFICATE NUMBER:2012 GL, Auto REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE 1HU SUER POLICYNUMBER MMLICYEFF MMMDYEXP LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED PREMISES E...cunencel $ 100,000 A CLAIMS-MADE OCCUR X 44CL46382202 /21/2012 3/21/2013 MED EXP(My one person) $ 5,000 PERSONAL&ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY EOMBINdEED SINGLE LIMB 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CP04681732 3/21/2012 3/21/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTO$ Per cciden PIP-Basic S 10,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNEWEXECUTIVE❑ NIA E.L.EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? --(Mandatory In NH) - E.L.DISEASE-EA EMPLOYE $ If es.tlescrice antler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ANach ACORD 101,Additional Remarks Schedule,dmore space Is required) Certificate holder included as additional insured as respects general liability where required by written contract. This form is subject to policy terms, conditions, and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Ashland MAR 2 0 2012 ACCORDANCE WITH THE POLICY PROVISIONS. Oregon Department ansportation 20 E Main St UTHORIZED REPRESENTATIVE Ashland, OR 97520 P Ortiz, CIC/PAUORT ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD `°RO® CERTIFICATE OF LIABILITY INSURANCE 3i5i2o�2 ' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in.lieu of such endorsement(s). PRODUCER CONTACT Paula Ortiz CIC NAME: Beecher Carlson Insurance Agency LLC PHONE (541)772-1111 FA% Not- Atc 707 Murphy Rd E4eAIL .Paula.ortiz @beechercarlson.com INSURERS AFFORDING COVERAGE NAIL k Medford OR 97504 INSURER A:Ameri.Can Hallmark Insurance Co INSURED INSURER B:Assurance Co of America 19305 Ashland Construction Inc, DBA: Southern 1 INSURER C: Oregon Concrete Pumping INSURER D: 102 Pleasant View INSURER E: Talent OR 97540 INSURER F: COVERAGES CERTIFICATE NUMBER:2012 GL, Auto REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER IMMIDDIYYYYI IMMIDDIYYYYli LIMns GENERAL LIABILITY EACH OCCURRENCE $ 11000.000 DAMAGE TORENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ A CLAIMS-MADE FxIOCCUR 14CL46382202 /21/2012 /21/2013 MED EXP(My one person) $ 5.000 SPTc INJURY $ 1.000.000 O Eci nY IT GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2•000•000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea MBINEDtSINGLE LIMIT 1 000 000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED CP04681732 /21/2012 /21/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS AUTO-0WNED 's'te"ten DAMAGE $ PIP-Basic $ 10 000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS DAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOMPARTNEWUECULVE❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule.H more apace Is required) 01' t.y. L' - i 1 MAR M2O 2(''2 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of ACCORDANCE WITH THE POLICY PROVISIONS. Ashland --- 20 E Main Street Ashland, OR 97520 AUTHORIZED REPRESENTATIVE P Ortiz, CIC/PAUORT ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).01 The ACORD name and logo are registered marks of ACORD